Provider Demographics
NPI:1508291774
Name:FAMILY FIRST HOMECARE, LLC
Entity Type:Organization
Organization Name:FAMILY FIRST HOMECARE, LLC
Other - Org Name:FAMILY FIRST HOMECARE OF JACKSONVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-850-0042
Mailing Address - Street 1:2203 N LOIS AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2387
Mailing Address - Country:US
Mailing Address - Phone:800-431-0706
Mailing Address - Fax:800-401-6576
Practice Address - Street 1:6800 SOUTHPOINT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6221
Practice Address - Country:US
Practice Address - Phone:904-204-2273
Practice Address - Fax:904-204-2274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY FIRST HOMECARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-06
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL123251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health